Archive for the ‘Physical activity’ Category

1. Someone somewhere may be fit but fat, but you are not one of them. And you’ll never be one of them either.

2. Losing even ten or twenty pounds can have positive health benefits.

3. Set goals and evaluate how you are doing at regular intervals. Every month or so, do a self-assessment and see how you are doing. Above all avoid gaining weight.

4. People who are overweight or obese know they are. They don’t need you to remind them or scold them. Be nice. It’s not easy to keep the weight off.

5. Obesity is not a personal moral failure, it’s a social (group) moral failure.

6. Avoid drugs and over the counter weight loss aids. They are unsafe or ineffective. Though surgery may help if you are severely obese.

7. Being too thin is a health risk as well. There are a lot of people with eating disorders and they need professional help and everyone’s deep sympathy and support.

8. There may be a sweet spot for maximum longevity around a BMI of about 26. This is just over the oversight line. But the maximum for overall good health is lower than that, squarely in the normal weight category.

9. Smoking to keep the weight off may work, but it’s extremely wrong.

10. Weight lifting is a critical part of healthy living. Everyone who can and should do it.

11. Buying cheap exercise equipment (and expensive equipment) so you’ll work out at home rarely works because most people don’t have the self-motivation to use it consistently.

1. It’s impossible to get enough physical activity solely by going to the gym. No one who is gainfully employed or in a relationship (or looking for one) can get to the gym consistently enough.

2. Therefore, you are going to have to incorporate physical activity into your day to day life. This means walking a half hour a day. Every day, good weather and bad.

3. Long commutes are bad for your health. You’ll never make up the time and you’ll spend far too much time sitting and being stressed.

4. Even a little regular physical activity is good if you are sedentary.

5. Take the stairs. Park further from your office or the mall entrance. Every step adds up.

6. Unless you are a college athlete, too much exercise doesn’t help. After about a half hour of vigorous physical activity, the marginal benefit declines.

7. It’s hard to get to the gym every day. And that fifth straight day at the gym doesn’t get you too much. Your body needs some rest.

8. Based purely on personal observation at the gym, one mistake beginners make is to spend too much time stretching. Five minutes is enough (there is little evidence that stretching helps prevent injuries though it may be good for long term heal and flexibility). But I’ve seen people spend half an hour or more stretching. They stretch rather than exercise. Not good. You only have so much time.

9. A personal trainer can be a great way to get fit or meet fitness goals. But not all are good. Avoid those that emphasize strange exercises that require help to perform. Or trainers that have you do dangerous exercises.

10. For me at least, there really is an exercise high where I feel invigorated. Try to see if you have can get there too

11. The advantage of a gym is that it is socially acceptable to check out the good looking bodies. But be discreet. Don’t be creepy.

12. Walking to get frozen yogurt does not improve health and fitness.

13. Don’t sit. Stand up every 15-20 minutes and walk some. This is good for your weight, back muscles, and eyes.

14. Walking seems to be good for mental health and avoiding cognitive decline. Walk. Walk as much and often as you can.

13. Unless you have a serious chronic illness, don’t bother with gluten free or other fad diets. If they appear to help, it’s most likely a placebo effect you’re experiencing. The other problem is that the more restrictive a diet is, the harder it is to keep to it.

14. If you do have a serious chronic illness, then definitely explore gluten free or other types of special diets. Though the science isn’t there yet, the anecdotal evidence is intriguing.

15. Don’t ever feed your children chicken tenders. Humanity existed for 100,000 years before they were invented. They may get you through a few picky eating years, but you’re setting your child up for a lifetime of bad eating habits and a taste for over indulging in salty processed fried food.

16. Keep adults away from the blue cheese and ranch dressings. Most salad dressings. They are all fat, salts, and sugar. You might as well put MnMs on your salad.

17. A little wine with dinner is good for you. If you have a substance abuse problem, No! Avoid any and all wine. Otherwise, have a glass at dinner. Just one glass. And maybe you shouldn’t drive after that.

18. Needing 8 glasses of water a day is a myth. But why not drink water instead if a soda or sweetened fruit drink.

19. Avoid sodas and most fruit drinks. They are bad whether sugar free or not.

20. Fasting may be good for spiritual health, but not for physical health. Do not fast.

21. A cleanse is pure pseudo-science. Avoid taking any advice from anyone who tells you it’s a good thing.

22. If it’s on the Internet, chances are it’s pure bunk.

23. Telling someone to talk to their doctor is the medical equivalent of the fine print in your cell phone contract. Your doctor doesn’t know because they weren’t trained in nutrition. The person giving you the advice is just covering their butt so they won’t get sued.

24. At any given meal, half your plate should be fruits and vegetables. Then some starch, preferably whole grain, then just a tiny amount of neat, if any. Eat your vegetables and fruits first.

25. Some things have to be eliminated from your daily life. Sorry, but no mochas, smoothies, cupcakes, etc. You grew up without a daily dose of these things, be a child and go without them again.

26. But limited your food intake does not mean a life of deprivation. Go for better quality food and savor what you do eat. And if it doesn’t taste great, don’t eat it.

28. Don’t grocery shop when you are hungry. You’ll be more likely to buy things that are bad for you.

29. Develop a repertoire of healthy, easy and quick to make meals. Then make them.

Allison Morris sent this to me. I found it profoundly important. The graphic comes from Insurance Quotes.

Inactivity Pandemic

Don’t be surprised (or insulted) if the next prescription your doctor hands you is for nothing but an exercise regimen. Globally, 20% of early deaths are preventable with moderate exercise. And for the first time last year, sitting killed 5.3 million people worldwide, more than smoking. Inactivity is now considered as a full-on pandemic by health officials. Many U.S. doctors are pushing to make a “lack of exercise” a mainstream medical diagnosis.

U.S. adults end up sitting for an average of 8-10 hours everyday. This makes the American lifestyle one of the most sedentary in the world. After long commutes and hours at our desks, we can hardly blame ourselves for posting up on the couch right when we get home. Luckily, getting enough exercise is a lot easier than most of us think. The American Medical Association says that just 150 minutes of moderate exercise is all it takes to drastically reduce the risk of lifestyle diseases like obesity, diabetes and heart diseases for most adults.

Due to a recent eye problem (I’m getting better – thanks for your concern), I have gone six months without being able to drive or ride a bike. Walking is the main way I get around these days and Boston, despite its reputation as a walking city, is not always that easy to navigate by foot and public transportation. But my world is rich enough in destinations: work, shopping, etc., that not being able to drive is a disadvantage, but not life stopping. I can take the MBTA, Boston’s public transportation system, to many places that are too far to walk. For a person with limited vision, Boston is not a city of limits.

But what percentage of the United States is accessible to those who cannot drive? A very tiny percentage. Sure there are rural areas that it would be nearly impossible to make accessible, I don’t know how public policy beyond providing transportation services could be of assistance here. But how many urban areas, big cities, in this country are off limits to those of us who cannot drive? What about those who can’t afford cars? This seems to me to be a civil rights issue. Shouldn’t our dense cities be accessible to those with limited eyesight?

The radical part of me wants to sue someone to make the Unite States more accessible (actually, what is more mainstream American than taking someone to court). I am not a lawyer, so I can’t speak to the specific legal and constitutional issues involved. But shouldn’t there be something about the equal protection clause or the Americans With Disabilities Act to take care of this? Should there be a constitutional right to access? I’m not a dreamer, I realize there is not a great chance of anyone ever taking this on and winning a case before the Supreme Court. But wouldn’t it be a better country if we made walkability a civil right issue?

A continuing issue regarding the influence of the built environment on health has been whether certain types of environments: sprawled metropolitan areas or unwalkable neighborhoods cause obesity or whether obese people simply choose these areas because they support a low physical activity lifestyle or make it easier for obese people to live there. Which came first: obesity or the neighborhood?

Part of the reason for this uncertainty is the nature of the evidence. Most of it comes from cross-sectional data (individuals are asked questions at a single point in time). A major limitation of these types of studies is that no conclusions about the directionality of the associations can be made.

There have been some attempts to use cohort data, information on a set of individuals collected at several or more time intervals. The problem with these datasets is that they aren’t very many of them and they tend to be small. Small studies may lack the statistical power to identify the subtle, but important, effects of sprawl on obesity, for example.

One of the few longitudinal datasets that can be used to study the built environment is the National Longitudinal Survey of Youth (NLSY) which consists of two national samples: persons who were born between 1957 and 1965 and the natural born children of mothers in the original cohort (a third cohort has been established but its oldest members are only 26, perhaps not yet old enough fo use in an obesity study). These cohorts were selected in order to enable study of how people entered the labor force and progressed their careers. These cohort has the essential features that are needed for a health and the environment study: place of residence (not publicly available but accessible upon special request), data on height and weight (collected to assess disability status) and data collected almost every other year since the cohort’s start date.

Reid Ewing used this dataset, in conjunction with his urban sprawl measure (developed in conjunction with Smart Growth America) to test the which came first problem. What he found was that the built environment (sprawl) did not seem to be associated with obesity in longitudinal analyses. Note that this does not directly put to rest which came first, only that the NLSY data doesn’t support the sprawl to obesity hypothesis. But the NLSY may be too small (only about 10,000 persons) to uncover the association. So the controversy continues.

There has been a great deal of research on residential choice. Economists and urban planners have been curious about this for years. They tend to find that affordability and school quality are the most important predictive factors for how a household chooses its location. Access to jobs is also important. These studies never included any data on walkability or urban design. They never considered that people would choose neighborhoods based on obesity status.

So as of this time, we cannot determine which came first: obesity or the neighborhood.

A year or so ago, public health advocates were trying to boost a campaign to convince every US resident to walk 10,000 steps. The reasons for this campaign are obvious: too many Americans are overweight or obese, too many are physically inactive or not getting enough physical activity. But how easy is it to walk 10,000 steps in a day? Thanks to the people at Active Living Research, I have a pedometer which I used for a couple of months to monitor my walking behavior.

How much do people walk now? I’ve heard estimates as low as a mean of a quarter mile a day, or about 500 steps at 2.5 feet per step. This seems way too low even for US physical activity, so I suspect the number refers to walking outside the home (probably reported from the National Household Transportation Survey). Let’s give Americans the benefit of the doubt and say they are currently walking a mean of 2 miles a day, or about 4000 steps. How are they going to get those other 6000 steps? This is about 3 miles, or given that people walk about 3 miles per hour, it means that they will need to spend an extra hour a day walking. How is that going to happen?

Unfortunately, it isn’t going to happen at home, work or school. Most people live pretty sedentary lives and even if they boosted their physical activity while at these places by 25% – a huge increase, they would still be short about 5000 steps or 2.5 miles. They will have only shaved 10 minutes off of that hour walking requirement. Can they make it up after school/work? Well that’s an hour away from dinner, family time, sleeping, playing with the kids, updating their facebook accounts, watching television etc. Not likely.

So they can only meet these extra steps by walking someplace, either to or from work/school or to and from some other destination. And that is only going to be possible if their homes are within walking distance of suitable destinations and the streets are safe for walking. I know this from my own experience with a pedometer. I only hit 10,000 steps on days I walked to work or walked around shopping or to my garden plot. On days I had to drive, I did not make my walking quota.

This is an example of how well meaning health advocates can propose ineffective solutions when they ignore the proper level (looking at the individual level instead of the neighborhood level) at which these problems occur. There may well be some physically inactive people who could walk to work/school or shop but don’t- these people could benefit from a campaign like the 10,000 steps program; but their number is most likely dwarfed by those who can’t walk to work/school because their worksite/school is too far to walk or it’s not safe to walk to these destinations. There may be too much traffic, no sidewalks, an unsafe area, no street lights, etc. The 10,000 program cannot motivate these people. The correct level of action is to address the neighborhood, community, or metropolitan area environment. This is where the problem originates and sets off a chain of causality that impacts people’s health. Therefore this is where the problem needs to be addressed.